Intra- and inter-observer reliability of ten major histological scoring systems used for the evaluation of in vivo cartilage repair

Bonasia, Davide Edoardo; Marmotti, A.; Massa, Alessandro Domenico Felice; Ferro, A.; Blonna, Davide; Castoldi, Filippo; Rossi, Roberto

doi:10.1007/s00167-014-2975-8

Cited by 24 publications

(22 citation statements)

References 40 publications

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“…We used the histological-histochemical grading system proposed by Mankin et al [ 52 ]. Even though this method is intended to be used for the grading of the human osteoarthritic cartilage, it has also been used in animal studies [ 53 , 54 ]. After 14 days, the samples stored at −70 °C and 4 °C exhibited slightly reduced safranin O staining with diffuse hypercellularity at the superficial cartilage layer and received the scores of 1.83 ± 0.75 and 1.4 ± 0.89, respectively (Fig.…”

Section: Resultsmentioning

confidence: 99%

Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts

Mickevičius

Pockevičius

Kučinskas

et al. 2015

BMC Musculoskelet Disord

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BackgroundOsteochondral allograft transplantation has a good clinical outcome, however, there is still debate on optimization of allograft storage protocol. Storage temperature and nutrient medium composition are the most critical factors for sustained biological activity of grafts before implantation. In this study, we performed a time-dependent in vitro experiment to investigate the effect of various storage conditions on electromechanical, histological and histochemical properties of articular cartilage.MethodsOsteochondral grafts derived from goat femoral condyles were frozen at −70 °C or stored at 4 °C and 37 °C in the medium supplemented with or without insulin-like growth factor-1 (IGF-1). After 14 and 28 days the cartilage samples were quantitatively analysed for electromechanical properties, glycosaminoglycan distribution, histological structure, chondrocyte viability and apoptosis. The results were compared between the experimental groups and correlations among different evaluation methods were determined.ResultsStorage at −70 °C and 37 °C significantly deteriorated cartilage electromechanical, histological and histochemical properties. Storage at 4 °C maintained the electromechanical quantitative parameter (QP) and glycosaminoglycan expression near the normal levels for 14 days. Although hypothermic storage revealed reduced chondrocyte viability and increased apoptosis, these parameters were superior compared with the storage at −70 °C and 37 °C. IGF-1 supplementation improved the electromechanical QP, chondrocyte viability and histological properties at 37 °C, but the effect lasted only 14 days. Electromechanical properties correlated with the histological grading score (r = 0.673, p < 0.001), chondrocyte viability (r = −0.654, p < 0.001) and apoptosis (r = 0.416, p < 0.02). In addition, apoptosis correlated with glycosaminoglycan distribution (r = −0.644, p < 0.001) and the histological grading score (r = 0.493, p = 0.006).ConclusionsOur results indicate that quality of allografts is better preserved at currently established 4 °C storage temperature. Storage at −70 °C or at 37 °C is unable to maintain cartilage function and metabolic activity. IGF-1 supplementation at 37 °C can enhance chondrocyte viability and improve electromechanical and histological properties of the cartilage, but the impact persists only 14 days. The correlations between cartilage electromechanical quantitative parameter (QP) and metabolic activity were detected. Our findings indicate that non-destructive assessment of cartilage by Arthro-BST is a simple and reliable method to evaluate allograft quality, and could be routinely used before implantation.

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Section: Resultsmentioning

confidence: 99%

Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts

Mickevičius

Pockevičius

Kučinskas

et al. 2015

BMC Musculoskelet Disord

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“…Other scoring systems commonly used in animal models include O’Driscoll, International Cartilage Repair Society (ICRS and ICRSII), and modified O’Driscol scores [ 189 , 201 , 202 ]. A recent study comparing the various histological scoring systems for OA showed that the ICRSII, O’Driscoll, and modified O’Driscoll scores had higher reliability than other histopathological scores, including the Mankin score [ 203 ].…”

Section: Measures Of Disease Outcomementioning

confidence: 99%

Animal models of osteoarthritis: classification, update, and measurement of outcomes

et al. 2016

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Osteoarthritis (OA) is one of the most commonly occurring forms of arthritis in the world today. It is a debilitating chronic illness causing pain and immense discomfort to the affected individual. Significant research is currently ongoing to understand its pathophysiology and develop successful treatment regimens based on this knowledge. Animal models have played a key role in achieving this goal. Animal models currently used to study osteoarthritis can be classified based on the etiology under investigation, primary osteoarthritis, and post-traumatic osteoarthritis, to better clarify the relationship between these models and the pathogenesis of the disease. Non-invasive animal models have shown significant promise in understanding early osteoarthritic changes. Imaging modalities play a pivotal role in understanding the pathogenesis of OA and the correlation with pain. These imaging studies would also allow in vivo surveillance of the disease as a function of time in the animal model. This review summarizes the current understanding of the disease pathogenesis, invasive and non-invasive animal models, imaging modalities, and pain assessment techniques in the animals.

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“…We conclude that the DefFill.V is the most important and robust parameter to describe the quality of the repair tissue based on UBM data. This is supported by Bonasia et al who found that the item "overall assessment" of ICRS-II is the most reliable of ten major histopathological classification systems (Bonasia et al, 2015). Furthermore, the comprehensive meta-analysis of Blackman et al (Blackman et al, 2013) revealed that the MOCART item "Degree of defect repair" shows the most significant correlations to clinical outcome measures, and according to Marlovits et al (Marlovits et al, 2006), the MOCART item "Degree of defect repair" also shows the best correlations to patient reported outcomes two years after autologous chondrocyte transplantation.…”

Section: Discussionmentioning

confidence: 60%

“…For cartilage repair outcomes the ICRS recommends the Cartilage Repair Assessment (CRA) scoring system in the ICRS Cartilage Injury Evaluation Package with three distinct categories: "degree of defect repair", "integration to border zone", and "macroscopic appearance". However, intraoperative scoring according to Outerbridge, ICRS, and ICRS-CRA scales involves a large subjective component resulting in high inter-observer variability (Bonasia et al, 2015;Cameron et al, 2003). In addition, macroscopic judgement of the cartilage repair outcome does not allow for assessment of the cartilage thickness unless the bone is exposed.…”

Section: Introductionmentioning

confidence: 99%

3D ultrasound biomicroscopy for assessment of cartilage repair tissue: volumetric characterisation and correlation to established classification systems

Schöne

Männicke

Somerson

et al. 2016

eCM

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Objective and sensitive assessment of cartilage repair outcomes lacks suitable methods. This study investigated the feasibility of 3D ultrasound biomicroscopy (UBM) to quantify cartilage repair outcomes volumetrically and their correlation with established classification systems. 32 sheep underwent bilateral treatment of a focal cartilage defect. One or two years post-operatively the repair outcomes were assessed and scored macroscopically (Outerbridge, ICRS-CRA), by magnetic resonance imaging (MRI, MOCART), and histopathology (O'Driscoll, ICRS-I and ICRS-II). The UBM data were acquired after MRI and used to reconstruct the shape of the initial cartilage layer, enabling the estimation of the initial cartilage thickness and defect volume as well as volumetric parameters for defect filling, repair tissue, bone loss and bone overgrowth. The quantification of the repair outcomes revealed high variations in the initial thickness of the cartilage layer, indicating the need for cartilage thickness estimation before creating a defect. Furthermore, highly significant correlations were found for the defect filling estimated from UBM to the established classification systems. 3D visualisation of the repair regions showed highly variable morphology within single samples. This raises the question as to whether macroscopic, MRI and histopathological scoring provide sufficient reliability. The biases of the individual methods will be discussed within this context. UBM was shown to be a feasible tool to evaluate cartilage repair outcomes, whereby the most important objective parameter is the defect filling. Translation of UBM into arthroscopic or transcutaneous ultrasound examinations would allow non-destructive and objective follow-up of individual patients and better comparison between the results of clinical trials.

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Intra- and inter-observer reliability of ten major histological scoring systems used for the evaluation of in vivo cartilage repair

Cited by 24 publications

References 40 publications

Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts

Impact of storage conditions on electromechanical, histological and histochemical properties of osteochondral allografts

Animal models of osteoarthritis: classification, update, and measurement of outcomes

3D ultrasound biomicroscopy for assessment of cartilage repair tissue: volumetric characterisation and correlation to established classification systems

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