A Comparative Study With In Vitro Ultrasonographic and Histologic Grading of Metatarsal Head Cartilage in Rheumatoid Arthritis.
BACKGROUND
Ultrasonography is among the valid methods to assess articular cartilage in the foot. This study aimed to evaluate the validity of ultrasonographic grading to assess metatarsal head articular cartilage for rheumatoid forefoot deformity in vivo and to compare the findings with in vitro ultrasonographic and histologic gradings.


METHODS
Participants were 15 patients scheduled to undergo resection arthroplasty of the metatarsal heads of the lesser toes because of rheumatoid arthritis of the metatarsophalangeal joints. Ultrasonographic examination was performed in vivo the day before surgery. Specimens of the second to fifth metatarsal heads taken intraoperatively were graded from in vitro ultrasonographic and histologic evaluations. Correlations among in vivo ultrasonographic, in vitro ultrasonographic, and histologic gradings were analyzed.


RESULTS
In 46 metatarsal heads, the distribution of grading ranged from grade 1 to 6 for in vivo ultrasonographic examinations and from grade 1 to 4 for histologic examinations. In vivo ultrasonographic grading showed significant correlation to both in vitro ultrasonographic grading (P < .001, R = 0.74) and histologic grading (P < .001, R = 0.67).


CONCLUSIONS
The significant correlations between in vivo ultrasonographic and histologic gradings suggest that a semiquantitative in vivo ultrasonographic assessment of forefoot deformity in rheumatoid arthritis may be possible. Ultrasonographic grading may prove useful for pre- and postoperative evaluation of remaining joint function in rheumatoid forefoot deformity. An ultrasonographic grading system for remaining joint surfaces might be helpful in selecting surgical procedures such as joint-sparing osteotomy and metatarsal head resection.


METHODS
Level IV, case series.
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan tomozou@med.hokudai.ac.jp.
Tomohiro
T
Onodera
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Yasuhiko
Y
Kasahara
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Toshiyuki
T
Kasemura
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Yuki
Y
Suzuki
Department of Advanced Therapeutic Research for Sports Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
Eiji
E
Kondo
Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Norimasa
N
Iwasaki
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D002358:Cartilage, Articular / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D005531:Foot Deformities, Acquired / Q000175:diagnosis*; D005545:Forefoot, Human / Q000002:abnormalities*; D006801:Humans; D008297:Male; D008682:Metatarsal Bones / Q000000981:diagnostic imaging* / Q000473:pathology*; D008875:Middle Aged; D014463:Ultrasonography
articular cartilage; forefoot deformity; histology; rheumatoid arthritis; ultrasonography