Image Guided Debridement of Articular Cartilage

膝关节疼痛的关节镜检查中常发现局灶性软骨缺损。这些软骨的早期迹象 退变通常不影响组织的全部厚度，因此很难通过 仅仅是表面成像。发现包括起泡、裂开和纤颤。虽然病灶清创术 软骨损伤经常是为了减缓这些损伤的进展，横断面 组织学分析表明，仅靠传统的关节镜表面成像往往会产生不完整的结果。 清创异常软骨或损伤邻近的正常软骨。我们的假设是，术中 横断面图像引导将允许外科医生更准确地识别、清创和 稳定受损的关节软骨。 光学相干层析成像(OCT)是一种红外光回声仪，可以为外科医生提供 高分辨率(10m)和近乎实时的关节软骨横断面图像 潜在的术中应用。我们已经证明，人类关节软骨的OCT成像具有很高的 与组织病理学一致，我们已经成功地在关节镜手术中临床使用OCT 对关节软骨进行成像。我们现在建议进行研究，首先确定横断面 成像提供了可量化的信息，可以改善对早期软骨损伤的识别。在世界上 第一个特定的目标，我们将检查软骨清创的完全性和体积的测量 使用伴有局限性软骨缺陷的膝关节进行清创时取出的软骨。的完备性 清创将根据清创后残留软骨的平整度进行评估，并在OCT和 组织形态计量学。软骨体积的变化将通过3.0T磁共振成像进行评估。在第二个目标中， 将采用随机对照临床试验设计来检验OCT引导下清创的疗效 在股骨内侧和外侧有局限性软骨病变的个体。这一目标将考验 假设在OCT引导下关节镜下清理局灶性软骨缺损会产生更平滑的结果，以及 通过患者的症状、功能和3.0T磁共振成像评价关节表面更加稳定。

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.