title: Ultrasound palpation for fast in-situ quantification of articular cartilage stiffness, thickness and relaxation capacity.
abstract: Most current cartilage testing devices require the preparation of excised samples and therefore do not allow intra-operative application for diagnostic purposes. The gold standard during open or arthroscopic surgery is still the subjective perception of manual palpation. This work presents a new diagnostic method of ultrasound palpation (USP) to acquire applied stress and strain data during manual palpation of articular cartilage. With the proposed method, we obtain cartilage thickness and stiffness. Moreover, repeated palpations allow the quantification of relaxation effects. USP measurements on elastomer phantoms demonstrated very good repeatability for both, stage-guided (97.2%) and handheld (96.0%) applications. The USP measurements were compared with conventional indentation experiments and revealed very good agreement on elastomer phantoms ([Formula: see text]) and good agreement on porcine cartilage samples ([Formula: see text]). Artificially degenerated cartilage samples showed reduced stiffness, weak capacity to relax after palpation and an increase of stiffness of approximately 50% with each single palpation. Intact cartilage was measured by USP directly at the patella (in situ) and after excision and removal of the subchondral bone (ex situ), leading to stiffness values of [Formula: see text] and [Formula: see text] ([Formula: see text]), respectively. The results demonstrate the potential of the USP system for cartilage testing, its sensitivity to degenerative changes and as a method for quantifying relaxation processes by means of repeated palpations. Furthermore, the differences in the results of in-situ and ex-situ measurements are of general interest, since such comparison has not been reported previously. We point out the limited comparability of ex-situ cartilage with its in-situ biomechanical behavior.
authors.affiliation: Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schöne
authors.affiliation: Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: R M
authors.initials: RM
authors.lastname: Schulz
authors.affiliation: Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Tzschätzsch
authors.affiliation: AO Research Institute Davos, Davos, Switzerland.
authors.forename: P
authors.initials: P
authors.lastname: Varga
authors.affiliation: Berlin-Brandenburg School for Regenerative Therapies, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. kay.raum@charite.de.
authors.forename: K
authors.initials: K
authors.lastname: Raum
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D002358:Cartilage, Articular / Q000000981:diagnostic imaging*; D010173:Palpation; D010329:Patella; D015203:Reproducibility of Results; D013552:Swine; D014463:Ultrasonography
keywords: Articular cartilage; Biomechanical testing; Degeneration; In-situ; Indentation; Stiffness; Ultrasound palpation