Comparison of cartilage histopathology assessment systems on human knee joints at all stages of osteoarthritis development

Abstract

Objective To compare the MANKIN and OARSI cartilage histopathology assessment systems using human articular cartilage from a large number of donors across the adult age spectrum representing all levels of cartilage degradation. Design Human knees (n=125 from 65 donors; age range 23–92) were obtained from tissue banks. All cartilage surfaces were macroscopically graded. Osteochondral slabs representing the entire central regions of both femoral condyles, tibial plateaus, and the patella were processed for histology and Safranin O – Fast Green staining. Slides representing normal, aged, and OA tissue were scanned and electronic images were scored online by five observers. Statistical analysis was performed for inter- and intra-observer variability, reproducibility and reliability. Results The inter-observer variability among five observers for the MANKIN system showed a similar good intra-class coefficient (ICC >0.81) as for the OARSI system (ICC >0.78). Repeat scoring by three of the five readers showed very good agreement (ICC >0.94). Both systems showed a high reproducibility among four of the five readers as indicated by the Spearman’s rho value. For the MANKIN system, the surface represented by lesion depth was the parameter where all readers showed an excellent agreement. Other parameters such as cellularity, Safranin O staining intensity and tidemark had greater inter-reader disagreement. Conclusion Both scoring systems were reliable but appeared too complex and time consuming for assessment of lesion severity, the major parameter determined in standardized scoring systems. To rapidly and reproducibly assess severity of cartilage degradation, we propose to develop a simplified system for lesion volume.

The effects of chitosan oligosaccharides on OPG and RANKL expression in a rat osteoarthritis model

“…Items for scoring were (i) cartilage structure (0-6), (ii) cartilage cells (0-3), (iii) Safranin O staining (0-4), and (iv) tidemark integrity (0-1).The modified Mankin's score range is from 0 to 14 and the higher the score, the more severe is the extent of osteoarthritis 20 .…”

The potential utility of high-intensity ultrasound to treat osteoarthritis

“…Changes in articular cartilage include collagen disruption, PG depletion, and cell death 2,82 . Changes in subchondral bone include sclerosis [thickening, Fig.…”

“…Changes in subchondral bone include sclerosis [thickening, Fig. 4] and changes in joint anatomy include the formation and development of osteophytes 2,14 . Osteophytes that restrict joint mobility are often removed surgically 1,83 .…”

Identification of the Tidemark Line of Calcification in Osteoarthritic Cartilage Using a Stain for Alkaline Phosphatase

“…Second, previous work regarding scoring joints for OA severity have suggested that cellularity and tidemark cause the most scoring discrepancy and need more consensus and/or better illustrations [40]. Our study provides a more clear illustration of the correlation of the tidemark and calcification under a variety of OA severities.…”