Role of medial abrasion phenomenon in the pathogenesis of knee osteoarthritis
Introduction
Osteoarthritis (OA) of the knee is the major cause of chronic musculoskeletal pain and is ranked as a main reason of mobility disability in elderly population. It is a disease process of uncertain multifactorial etiology, which eventually affects the entire joint. Various etiologic risk factors have been proposed, but the exact pathogenesis for OA knee is unknown so far.
Many literatures mentioned medial compartment is more commonly involved than the lateral one and the pathogenesis may be different [1], [2], [3], [4], [5], [6], [7]. In 2006, it was reported that in patients with medial compartment osteoarthritic knees, the prevalence of medial plica was significantly higher than that of others and that two distinct foci of cartilaginous lesion were found on the facing medial femoral condyle in almost all of the patients who had the structure of medial plica [8]. A further study disclosed the kinematic relationship of the medial plica with the medial femoral condyle during knee motion in vivo [9]. In that study, it was revealed that all medial plicae, regardless of their size, would move reciprocally and would keep in touch with the medial femoral condyle and therefore might cause some degree of abrasion on the facing medial femoral condyle during knee motion. Another histomorphological study of the medial plica also implied the close interplay between this structure and the medial femoral condyle in patients with knee OA [10].
Section snippets
The hypothesis
We postulated that in the knee having the structure of medial plica demonstrating medial abrasion phenomenon, the repeated abrasion and impingement between medial plica and medial femoral condyle would elicit both physical and chemical effects on the adjacent cartilage and the medial plica itself which might play a role in the pathogenesis of knee OA.
Construction of three-dimensional dynamic finite element model
An experimental study on the tensile strength of the medial plica from 50 knees was conducted using high precision micro-force tensile tests [11]. The force–deflection curves resulting from these tests were transferred to stress–strain curves to obtain Young’s moduli of these specimens. In another selected 30 knees with different sizes of medial plica [9], the inner margins of the plicae were located by inserting needles percutaneously under direct vision during arthroscopic examination. The
New evidence: total protein, TNF-α, IL-1β and MMP-3 concentrations are higher in the medial compartment of the knee with medial abrasion phenomenon
There are a variety of proteins or debris in the synovial fluid of osteoarthritic knee. These proteins include glycoprotein debris and collagen fragments derived from destructed cartilaginous tissue and enzymes such as metalloproteinase, collagenase and proinflammatory cytokines (ILs, TNF-α, etc) [17], [18], [19]. All of these proteins in synovial fluid might reflect the pathological status of the knees. It has been reported that cartilage debris in the traumatized and osteoarthritic joint may
Consequences of the hypothesis and conclusion
In summary, our hypothesis points to the role of medial abrasion phenomenon in the pathogenesis of knee OA. There is accumulating evidence to suggest that both the physical and chemical effects elicited by the lifelong interplay between medial plica and the facing medial femoral condyle may contribute to the development and progression of knee OA. The consequent clinical applications of this hypothesis have provided benefits to the patients. If our hypothesis is confirmed by further
Conflict of interest
There is no conflict of interest.
Contributions
SR Lyu designed the study, provided materials, drafted and critically revised the article for important intellectual content. JY Cherng, YC Huang, CH Li, YJ Lin and CM Chang collected, assembled and statistically analyzed the data. CY Chiang and LK Chau analyzed and interpreted the data, drafted and finally approved the article.
Acknowledgement
This work was supported by the Tzu-Chi Dalin General Hospital, Chiayi, Taiwan.
References (37)
- et al.
Increased knee joint loads during walking are present in subjects with knee osteoarthritis
Osteoarthritis Cartilage
(2002) - et al.
Genetic influence on the progression of radiographic knee osteoarthritis: a longitudinal twin study
Osteoarthritis Cartilage
(2007) - et al.
Medial plicae and degeneration of the medial femoral condyle
Arthroscopy
(2006) Relationship of medial plica and medial femoral condyle during flexion
Clin Biomech (Bristol, Avon)
(2007)- et al.
Mechanical strength of mediopatellar plica-the influence of its fiber content
Clin Biomech (Bristol, Avon)
(2006) - et al.
Relationship between medial plica and medial femoral condyle – a three-dimensional dynaic finite element model
Clin Biomech (Bristol, Avon)
(2013) - et al.
Cartilage debris increases the expression of chondrodestructive tumor necrosis factor-alpha by articular chondrocytes
Arthroscopy
(2004) - et al.
Mitochondrial activity is modulated by TNFalpha and IL-1beta in normal human chondrocyte cells
Osteoarthritis Cartilage
(2006) - et al.
Modulation of TGF-beta signaling by proinflammatory cytokines in articular chondrocytes
Osteoarthritis Cartilage
(2007) - et al.
Expression of proteinase-activated receptors (PAR)-2 in articular chondrocytes is modulated by IL-1beta, TNF-alpha and TGF-beta
Osteoarthritis Cartilage
(2006)
Correlation between osteoarthritic cartilage damage and levels of proteinases and proteinase inhibitors in synovial fluid from the knee joint
Arthroscopy
Prevalence of radiographic knee osteoarthritis in Saudi Arabia
Clin Rheumatol
One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression subcohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status
Ann Rheum Dis
Epidemiology and features of knee osteoarthritis in the Ivory Coast
Revue du rhumatisme (English ed)
Distribution of radiographic osteoarthritis between the right and left hands, hips, and knees
Arthritis Rheum
Prevalence of knee osteoarthritis and analysis of pain, rigidity, and functional incapacity
Orthopedics
Medial plica in patients with knee osteoarthritis: a histomorphological study
Knee Surg Sports Traumatol Arthrosc
Matrix metalloprotease-3 expression in the medial plica and pannus-like tissue in knees from patients with medial compartment osteoarthritis
Histopathology
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