Knee cartilage of spinal cord-injured patients displays progressive thinning in the absence of normal joint loading and movement.
OBJECTIVE
Alterations in the morphologic, biochemical, and mechanical properties of cartilage occur after unloading and immobilization in animals. However, the findings have been inconsistent and it is unclear whether such changes also take place in humans. This study tested the hypothesis that progressive thinning of knee joint cartilage is observed after spinal cord injury.


METHODS
In this in vivo study, knee cartilage was assessed in patients with complete, traumatic spinal cord injury at 6 (n = 9), 12 (n = 11), and 24 months (n = 6) after injury. Morphologic parameters of the knee cartilage (mean and maximum thickness as well as surface area) were computed from magnetic resonance imaging (MRI) data, and results were compared with those in young, healthy volunteers (n = 9).


RESULTS
After 6 months of injury, the mean articular-cartilage thickness was significantly less in the patella and medial tibia (decrease of 10% and 16%, respectively; P < 0.05), but not in the lateral tibia (decrease of 10%), compared with the MRI findings in healthy volunteers. After 12 and 24 months of injury, the differences amounted to a reduction of 21% and 23%, respectively, in the patella, 24% and 25%, respectively, in the medial tibia, and 16% and 19%, respectively, in the lateral tibia. The changes were significant in all 3 surfaces of the spinal cord-injured joint cartilage (P < 0.05-0.01).


CONCLUSIONS
Our data show, for the first time, that progressive thinning (atrophy) of human cartilage occurs in the absence of normal joint loading and movement. This may have important implications for patient management, in particular for spinal cord-injured patients and patients who are immobilized after surgery.
Vanwanseele
B
B
Swiss Federal Institute of Technology, Zurich, Switzerland, Catholic University Leuven, Leuven, Belgium. banwanseele@biomedch.mat.ethz.ch
Eckstein
F
F
Knecht
H
H
Stüssi
E
E
Spaepen
A
A
D000328:Adult; D002358:Cartilage, Articular / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000473:pathology; D016059:Range of Motion, Articular; D013119:Spinal Cord Injuries / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D013977:Tibia / Q000473:pathology; D016474:Weight-Bearing / Q000502:physiology