Many musculoskeletal disorders (MDs) are associated with irreversible bone and cartilage damage; this is particularly true for osteoarthritis (OA). Therefore, a clinical need exists for modalities which can detect OA and other MDs at early stages. Optical coherence tomography (OCT) is an infrared-based imaging, currently FDA approved in cardiology and ophthalmology, which has a resolution greater than 10 microns and acquisition rate of 120 frames/second. It has shown feasibility for imaging early OA, identifying changes prior to cartilage thinning both in vitro and in vivo in patients and in OA animal models. In addition, OCT has shown an ability to identify early rheumatoid arthritis (RA) and guide tendon repair, but has the potential for an even greater impact. Clinical trials in OA are currently underway, as well as in several other MDs. 1. Introduction Musculoskeletal diseases are one of the leading causes of disability in the United States. Fifty million adults in USA have been diagnosed with arthritis, rheumatoid arthritis, gout, systemic lupus erythematosus, or fibromyalgia, and approximately 1 in 3 people between ages 18 to 64 with diagnosed arthritis have work limitations [1, 2]. Similarly, disease of the periarticular structures, such as tendons and ligaments, contributes to additional disabilities and limitations. Full- or partial-thickness tears of rotator cuff tendons (RCT) are relatively common; they occur in approximately 30% of the population and represent around 4.5 million clinic visits and 40,000 surgeries in the USA per year [3]. Arthritis also affects the pediatric population, with an estimate 294,000 children under the age of 18, or 1 in every 250, having some form of arthritic or rheumatologic condition [4]. Studies estimate that by the year 2030, 67 million Americans older than 18 years will have doctor-diagnosed arthritis [5]. This paper examines the potential of the new micron-scale imaging technology and optical coherence tomography (OCT), for the management of musculoskeletal disease. It focuses on the existing clinical need for a high-resolution micron-scale imaging system in the field of orthopedics, including osteoarthritis (OA), rheumatoid arthritis (RA), and rotator cuff repair (RCR). However, this is far from the full extent of potential applications. Early detection of disease, understanding early disease markers, and accurate assessment of tissue microstructure are necessary to increase success of treatment, reduce patient morbidity, and determine the progress of future therapeutics in hopes of improving patient
References
[1]
J. Bolen, J. Sniezek, K. Theis, et al., “Racial/ethnic differences in the prevalence and impact of doctordiagnosed arthritis—United States, 2002,” Morbidity and Mortality Weekly Report, vol. 54, pp. 119–123, 2005.
[2]
J. Hootman, J. Bolen, C. Helmick, and G. Langmaid, “Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation,” Morbidity and Mortality Weekly Report, vol. 55, no. 40, pp. 1089–1092, 2006.
[3]
L. S. Oh, B. R. Wolf, M. P. Hall, B. A. Levy, and R. G. Marx, “Indications for rotator cuff repair: a systematic review,” Clinical Orthopaedics and Related Research, no. 455, pp. 52–63, 2007.
[4]
J. J. Sacks, C. G. Helmick, Y. H. Luo, N. T. Ilowite, and S. Bowyer, “Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001–2004,” Arthritis Care and Research, vol. 57, no. 8, pp. 1439–1445, 2007.
[5]
J. M. Hootman and C. G. Helmick, “Projections of US prevalence of arthritis and associated activity limitations,” Arthritis and Rheumatism, vol. 54, no. 1, pp. 226–229, 2006.
[6]
J. M. Herrmann, C. Pitris, B. E. Bouma et al., “High resolution imaging of normal and osteoarthritic cartilage with optical coherence tomography,” Journal of Rheumatology, vol. 26, no. 3, pp. 627–635, 1999.
[7]
W. Drexler, D. Stamper, C. Jesser et al., “Correlation of collagen organization with polarization sensitive imaging of in vitro cartilage: implications for osteoarthritis,” Journal of Rheumatology, vol. 28, no. 6, pp. 1311–1318, 2001.
[8]
X. Li, S. D. Martin, C. Pitris, et al., “High-resolution optical coherence tomography imaging of osteoarthritic cartilage during open knee surgery,” Arthritis Research & Therapy, vol. 7, pp. R318–R323, 2005.
[9]
K. Zheng, S. D. Martin, C. H. Rashidifard, B. Liu, and M. E. Brezinski, “In vivo micron-scale arthroscopic imaging of human knee osteoarthritis with optical coherence tomography: comparison with magnetic resonance imaging and arthroscopy,” American Journal of Orthopedics, vol. 39, no. 3, pp. 122–125, 2010.
[10]
S. D. Martin, N. A. Patel, S. B. Adams et al., “New technology for assessing microstructural components of tendons and ligaments,” International Orthopaedics, vol. 27, no. 3, pp. 184–189, 2003.
[11]
C. Rashidifard, S. D. Martin, N. Kumar, et al., “Single detector polarization-sensitive optical coherence tomography for assessment of rotator cuff tendon integrity,” American Journal of Orthodontics, vol. 41, no. 8, pp. 351–357, 2012.
[12]
S. B. Adams, P. R. Herz, D. L. Stamper et al., “High-resoution imaging of progressive articular cartilage degeneration,” Journal of Orthopaedic Research, vol. 24, no. 4, pp. 708–715, 2006.
[13]
C. Vercollone, C. Rashidifard, S. Zan, et al., “New technological approach to study rotator cuff pathology,” Journal of Musculoskeletal Research, vol. 15, no. 1, p. 1250010, 2012.
[14]
M. E. Brezinski, Optical Coherence Tomography: Principles and Applications, Academic Press, Burlington, Mass, USA, 2006.
[15]
G. J. Tearney, M. E. Brezinski, B. E. Bouma et al., “In vivo endoscopic optical biopsy with optical coherence tomography,” Science, vol. 276, no. 5321, pp. 2037–2039, 1997.
[16]
S. A. Boppart, B. E. Bouma, C. Pitris, G. J. Fujimoto, and M. E. Brezinski, “Foward-scanning instruments for optical coherence tomographic imaging,” Optics Letters, vol. 21, no. 7, pp. 543–545, 1998.
H. J. Mankin, H. Dorfman, L. Lippiello, and A. Zarins, “Biochemical and metabolic abnormalities in articular cartilage from osteo-arthritic human hips. II. Correlation of morphology with biochemical and metabolic data,” Journal of Bone and Joint Surgery A, vol. 53, no. 3, pp. 523–537, 1971.
[19]
A. Hulth, L. Lindberg, and H. Telhag, “Mitosis in human osteoarthritic cartilage,” Clinical Orthopaedics and Related Research, vol. 84, pp. 197–199, 1972.
[20]
J. Ryu, B. V. Treadwell, and H. J. Mankin, “Biochemical and metabolic abnormalities in normal and osteoarthritic human articular cartilage,” Arthritis and Rheumatism, vol. 27, no. 1, pp. 49–57, 1984.
[21]
L. Lippiello, D. Hall, and H. J. Mankin, “Collagen synthesis in normal and osteoarthritic human cartilage,” Journal of Clinical Investigation, vol. 59, no. 4, pp. 593–600, 1977.
[22]
K. D. Brandt, “Enhanced extractability of articular cartilage proteoglycans in osteoarthrosis,” Biochemical Journal, vol. 143, no. 2, pp. 475–478, 1974.
[23]
R. D. Altman, J. C. Pita, and D. S. Howell, “Degradation of proteoglycans in human osteoarthritic cartilage,” Arthritis and Rheumatism, vol. 16, no. 2, pp. 179–185, 1973.
[24]
V. C. Mow, A. Ratcliffe, and A. R. Poole, “Cartilage and diarthrodial joints as paradigms for hierarchical materials and structures,” Biomaterials, vol. 13, no. 2, pp. 67–97, 1992.
[25]
D. Heinegard, S. Inerot, J. Wieslander, and G. Lindblad, “A method for the quantification of cartilage proteoglycan structures liberated to the synovial fluid during developing degenerative joint disease,” Scandinavian Journal of Clinical and Laboratory Investigation, vol. 45, no. 5, pp. 421–427, 1985.
[26]
J. Witter, P. J. Roughley, and C. Webber, “The immunologic detection and characterization of cartilage proteoglycan degradation products in synovial fluids of patients with arthritis,” Arthritis and Rheumatism, vol. 30, no. 5, pp. 519–529, 1987.
[27]
H. S. Cheung, L. M. Ryan, F. Kozin, and D. J. McCarty, “Identification of collagen subtypes in synovial fluid sediments from arthritic patients,” American Journal of Medicine, vol. 68, no. 1, pp. 73–79, 1980.
[28]
R. Kitridou, D. J. McCarty, D. J. Prockop, and K. Hummeler, “Identification of collagen in synovial fluid,” Arthritis and Rheumatism, vol. 12, no. 6, pp. 580–588, 1969.
[29]
W. D. Fisher, B. E. Golds, and M. van der Rest, “Stimulation of collagenase secretion from rheumatoid synovial tissue by human collagen peptides. Evidence of autoimmunity,” Journal of Bone and Joint Surgery A, vol. 64, no. 4, pp. 546–557, 1982.
[30]
H. M. Hanauske-Abel, B. F. Pontz, and H. U. Schorlemmer, “Cartilage specific collagen activates macrophages and the alternative pathway of complement: evidence for an immunopathogenic concept of rheumatoid arthritis,” Annals of the Rheumatic Diseases, vol. 41, no. 2, pp. 168–176, 1982.
[31]
M. Goto, S. Yoshinoya, T. Miyamoto et al., “Stimulation of interleukin-1α and interleukin-1β release from human monocytes by cyanogen bromide peptides of type II collagen,” Arthritis and Rheumatism, vol. 31, no. 12, pp. 1508–1514, 1988.
[32]
H. J. Mankin and K. D. Brandt, “Biochemistry and metabolism of articular cartilage in osteoarthritis,” in Osteoarthritis: Diagnosis and Management, R. W. Moskowitz, D. S. Howell, V. C. Goldberg, and H. J. Mankin, Eds., p. 109, WB Saunders, Philadelphia, Pa, USA, 2nd edition, 1992.
[33]
P. D. Byer, M. T. Baylis, A. Maroudas, et al., “Hypothesizing about joints,” in Studies in Joint Diseases 2, A. Maroudas and E. J. Holborow, Eds., p. 241, Pitman, London, UK, 1983.
[34]
S. A. Jimenez, L. Ala-Kokko, N. Ahmad, et al., “Type II collage gene mutations in familial osteoarthritis,” in Articular Cartilage and Osteoarthritis (Workshop), K. E. Kuettner, R. Schleyerbach, J. G. Peyron, and V. C. Hascall, Eds., p. 167, Raven Press, New York, NY, USA, 1992.
[35]
J. Mizrahi, A. Maroudas, and Y. Lanir, “The 'instantaneous' deformation of cartilage: effects of collagen fiber orientation and osmotic stress,” Biorheology, vol. 23, no. 4, pp. 311–330, 1986.
[36]
J. P. G. Urban, “The chondrocyte: a cell under pressure,” British Journal of Rheumatology, vol. 33, no. 10, pp. 901–908, 1994.
[37]
D. T. Felson, C. E. Chaisson, C. L. Hill et al., “The association of bone marrow lesions with pain in knee osteoarthritis,” Annals of Internal Medicine, vol. 134, no. 7, pp. 541–549, 2001.
[38]
G. H. Lo, D. J. Hunter, Y. Zhang et al., “Bone marrow lesions in the knee are associated with increased local bone density,” Arthritis and Rheumatism, vol. 52, no. 9, pp. 2814–2821, 2005.
[39]
B. Liu, M. Harman, S. Giattina et al., “Characterizing of tissue microstructure with single-detector polarization-sensitive optical coherence tomography,” Applied Optics, vol. 45, no. 18, pp. 4464–4479, 2006.
[40]
N. A. Patel, D. L. Stamper, and S. Plummer, “Spectroscopic assessment of osteoarthritic cartilage with optical coherence tomography,” Arthritis and Rheumatism, vol. 46, no. 9, pp. S497–S497, 2002.
[41]
D. Huang, E. A. Swanson, C. P. Lin et al., “Optical coherence tomography,” Science, vol. 254, no. 5035, pp. 1178–1181, 1991.
[42]
L. C. U. Junqueira, G. Bignolas, and R. R. Brentani, “Picrosirius staining plus polarization microscopy, a specific method for collagen detection in tissue sections,” Histochemical Journal, vol. 11, no. 4, pp. 447–455, 1979.
[43]
L. C. U. Junqueira, M. T. Assis Figueiredo, H. Torloni, and G. S. Montes, “Differential histologic diagnosis of osteoid. A study on human osteosarcoma collagen by the histochemical picrosirius-polarization method,” Journal of Pathology, vol. 148, no. 2, pp. 189–196, 1986.
[44]
B. Liu, M. Harman, S. Giattina et al., “Characterizing of tissue microstructure with single-detector polarization-sensitive optical coherence tomography,” Applied Optics, vol. 45, no. 18, pp. 4464–4479, 2006.
[45]
B. Liu, C. Vercollone, and M. E. Brezinski, “Towards improved collagen assessment: polarization-sensitive optical coherence tomography with tailored reference arm polarization,” International Journal of Biomedical Imaging, vol. 2012, Article ID 892680, 2012.
[46]
K. Yamaguchi, K. Ditsios, W. D. Middleton, C. F. Hildebolt, L. M. Galatz, and S. A. Teefey, “The demographic and morphological features of rotator cuff disease: a comparison of asymptomatic and symptomatic shoulders,” Journal of Bone and Joint Surgery A, vol. 88, no. 8, pp. 1699–1704, 2006.
[47]
C. Milgrom, M. Schaffler, S. Gilbert, and M. Van Holsbeeck, “Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender,” Journal of Bone and Joint Surgery B, vol. 77, no. 2, pp. 296–298, 1995.
[48]
D. G. Duckworth, K. L. Smith, B. Campbell, and F. A. Matsen, “Self-assessment questionnaires document substantial variability in the clinical expression of rotator cuff tears,” Journal of Shoulder and Elbow Surgery, vol. 8, no. 4, pp. 330–333, 1999.
[49]
M. Zanetti, B. Jost, J. Hodler, and C. Gerber, “MR imaging after rotator cuff repair: full-thickness defects and bursitis-like subacromial abnormalities in asymptomatic subjects,” Skeletal Radiology, vol. 29, no. 6, pp. 314–319, 2000.
[50]
H. Ellman, “Surgical treatment of rotator cuff rupture,” in Surgical Disorders of the Shoulder, M. S. Watson, Ed., pp. 283–291, Churchill Livingstone Company, London, UK, 1991.
[51]
H. Sano, H. Ishii, G. Trudel, and H. K. Uhthoff, “Histologic evidence of degeneration at the insertion of 3 rotator cuff tendons: a comparative study with human cadaveric shoulders,” Journal of Shoulder and Elbow Surgery, vol. 8, no. 6, pp. 574–579, 1999.
[52]
H. K. Uhthoff and H. Sano, “Pathology of failure of the rotator cuff tendon,” Orthopedic Clinics of North America, vol. 28, no. 1, pp. 31–41, 1997.
[53]
D. Liem, S. Lichtenberg, P. Magosch, and P. Habermeyer, “Magnetic resonance imaging of arthroscopic supraspinatus tendon repair,” Journal of Bone and Joint Surgery A, vol. 89, no. 8, pp. 1770–1776, 2007.
[54]
L. M. Galatz, C. M. Ball, S. A. Teefey, W. D. Middleton, and K. Yamaguchi, “The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears,” Journal of Bone and Joint Surgery A, vol. 86, no. 2, pp. 219–224, 2004.
[55]
L. Lafosse, R. Brozska, B. Toussaint, and R. Gobezie, “The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique,” Journal of Bone and Joint Surgery A, vol. 89, no. 7, pp. 1533–1541, 2007.
[56]
S. Wakitani, T. Goto, S. J. Pineda et al., “Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage,” Journal of Bone and Joint Surgery A, vol. 76, no. 4, pp. 579–592, 1994.
[57]
W. G. Wang, S. Q. Lou, X. D. Ju, K. Xia, and J. H. Xia, “In vitro chondrogenesis of human bone marrow-derived mesenchymal progenitor cells in monolayer culture: activation by transfection with TGF-β2,” Tissue and Cell, vol. 35, no. 1, pp. 69–77, 2003.
[58]
Y. Koike, G. Trudel, and H. K. Uhthoff, “Formation of a new enthesis after attachment of the supraspinatus tendon: a quantitative histologic study in rabbits,” Journal of Orthopaedic Research, vol. 23, no. 6, pp. 1433–1440, 2005.
[59]
M. J. Silva, T. M. Ritty, K. T. Ditsios, and et.al., “Morphological, cellular, and biomechanical changes in flexor tendon following insertion site injury,” Transactions of Orthopaedic Res Society, vol. 28, article 797, 2003.
[60]
P. O. Bagnaninchi, Y. Yang, M. Bonesi et al., “In-depth imaging and quantification of degenerative changes associated with Achilles ruptured tendons by polarization-sensitive optical coherence tomography,” Physics in Medicine and Biology, vol. 55, no. 13, pp. 3777–3787, 2010.
[61]
P. Cernohorsky, D. M. de Bruin, M. van Herk, et al., “In-situ imaging of articular cartilage of the first carpometacarpal joint using co-registered optical coherence tomography and computed tomography,” Journal of Biomedical Optics, vol. 17, no. 6, Article ID 060501, 2012.
[62]
D. Aletaha, T. Neogi, and A. J. Silman, “2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative,” Annals of the Rheumatic Diseases, vol. 69, no. 10, article 1580, 2010.
[63]
E. Suresh, “Recent advances in rheumatoid arthritis,” Postgraduate Medical Journal, vol. 86, no. 1014, pp. 243–250, 2010.
[64]
R. Landewé, “Predictive markers in rapidly progressing rheumatoid arthritis,” Journal of Rheumatology, vol. 34, no. 80, pp. 8–15, 2007.
[65]
R. F. von Vollenohower, “Treatment of rheumatoid arthritis: state of the art,” Nature Reviews Rheumatology, vol. 5, no. 10, pp. 531–541, 2009.
[66]
K. G. Saag, G. G. Teng, N. M. Patkar, et al., “Recommendations for the use of nonbiologic and biologic disease modifying anti-rheumatic drugs in RA,” Arthritis & Rheumatism, vol. 59, pp. 762–784, 2008.
[67]
K. Zheng, M. A. Rupnik, B. Liu, and M. E. Brezinski, “Three dimensional oct in the engineering of tissue constructs: a potentially powerful tool for assessing optimal scaffold structure,” Open Tissue Engineering and Regenerative Medicine Journal, vol. 2, pp. 8–13, 2009.
[68]
J. Rogowska, N. A. Patel, J. G. Fujimoto, and M. E. Brezinski, “Optical coherence tomographic elastography technique for measuring deformation and strain of atherosclerotic tissues,” Heart, vol. 90, no. 5, pp. 556–562, 2004.
[69]
J. Rogowska, N. Patel, S. Plummer, and M. E. Brezinski, “Quantitative optical coherence tomographic elastography: method for assessing arterial mechanical properties,” British Journal of Radiology, vol. 79, no. 945, pp. 707–711, 2006.
[70]
M. E. Brezinski and B. Liu, “Nonlocal quantum macroscopic superposition in a high-thermal low-purity state,” Physical Review A, vol. 78, no. 6, Article ID 063824, 2008.
[71]
M. E. Brezinski, “Nonlocal quantum correlations: beyond entanglement,” In press, http://arxiv.org/abs/1209.1081.
