Image Guided Debridement of Articular Cartilage

局部软骨缺损是关节镜检查中常见的膝关节疼痛。这些软骨的早期症状 变性通常不影响组织的整个厚度， 表面成像。结果包括起泡、开裂和纤维性颤动。虽然病灶清创术 经常进行软骨缺损以试图减缓这些缺损的进展， 组织学分析表明，传统的关节镜表面成像单独往往产生不完整的， 异常软骨的清创或对邻近正常软骨的损伤。我们的假设是术中 横截面图像引导将允许外科医生更精确地识别、清创和 稳定受损关节软骨。 光学相干断层扫描（OCT）是一种红外光回波图，可为外科医生提供 关节软骨的高分辨率（10 m）和接近真实的时间的横截面图像， 潜在的术中使用。我们已经表明，OCT成像的人关节软骨有很高的 与组织病理学一致，我们在关节镜手术中成功地在临床上使用OCT， 关节软骨成像。我们现在建议进行研究，首先确定是否有横截面 成像提供了可量化的信息，其可改善早期软骨损伤的识别。在该 第一个具体目标是，我们将检查软骨清创术的完整性和 在清创期间使用具有局灶性软骨缺损的膝关节软骨切除。完整性 清创术将通过清创残余软骨的光滑度以及OCT和 组织形态计量学将通过3.0T MRI评估软骨体积的变化。在第二个目标中，A 随机对照临床试验设计将用于检查OCT引导清创术的有效性 在内侧和外侧股骨髁有局灶性软骨损伤的个体中。这一目标将考验 假设OCT引导的关节镜下局部软骨缺损清创术导致更平滑， 根据患者症状、功能和3.0 T MRI评估，关节面更稳定。

Focal cartilage defects are commonly found at arthroscopy for knee pain. These early signs of cartilage degeneration frequently do not affect the full thickness of the tissue and thus may be difficult to assess by surface imaging alone. Findings include blistering, fissuring, and fibrillation. Although debridement of focal cartilage defects is frequently performed in an attempt to slow progression of these defects, cross-sectional histological analysis shows that conventional arthroscopic surface imaging alone often yields incomplete debridement of abnormal cartilage or damage to adjacent normal cartilage. Our hypothesis is that intraoperative cross-sectional image guidance would allow the surgeon to more precisely identify, debride and stabilize damaged articular cartilage. Optical Coherence Tomography (OCT) is an echograph of infrared light that can provide the surgeon with cross-sectional images of articular cartilage at high resolution (10m) and in near real time allowing for potential intra-operative use. We have shown that OCT imaging of human articular cartilage has high agreement with histopathology, and we have successfully used OCT clinically during arthroscopic surgery to image articular cartilage. We now propose to perform studies to first determine whether cross-sectional imaging provides quantifiable information that can improve identification of early cartilage lesions. In the the first specific aim we will examine measures of the completeness of cartilage debridement and the volume of cartilage removed during debridement using cadveric knees with focal cartilage defects. Completeness of debridement will be assessed by the smoothness of the debrided residual cartilage, and by OCT and histomorphometry. Changes in cartilage volume will be assessed by 3.0T MRI. In the second aim, a randomized controlled clinical trial design will be utilized to examine the efficacy of OCT guided debridement in individuals with focal cartilage lesions in the medial and lateral femoral condyles. This aim will test the hypothesis that OCT-guided arthroscopic debridemeent of focal cartilage defects results in a smoother, and more stable articular surface as assessed by patient symptoms, function and 3.0 T MRI.