University of Oulu

Hellberg, I., Karjalainen, V.-P., Finnilä, M. A. J., Jonsson, E., Turkiewicz, A., Önnerfjord, P., Hughes, V., Tjörnstrand, J., Englund, M., & Saarakkala, S. (2023). 3D analysis and grading of calcifications from ex vivo human meniscus. In Osteoarthritis and Cartilage (Vol. 31, Issue 4, pp. 482–492). Elsevier BV.

3D analysis and grading of calcifications from ex vivo human meniscus

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Author: Hellberg, I.1; Karjalainen, V.-P.1; Finnilä, M. A. J.1;
Organizations: 1Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
2Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
3Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Rheumatology and Molecular Skeletal Biology, Lund, Sweden
4Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden
5Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2 MB)
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Language: English
Published: Elsevier, 2022
Publish Date: 2023-11-06


Objective: Meniscal calcifications are associated with the pathogenesis of knee osteoarthritis (OA). We propose a micro-computed tomography (μCT) based 3D analysis of meniscal calcifications ex vivo, including a new grading system.

Method: Human medial and lateral menisci were obtained from 10 patients having total knee replacement for medial compartment OA and 10 deceased donors without knee OA (healthy references). The samples were fixed; one subsection was imaged with μCT, and the adjacent tissue was processed for histological evaluation. Calcifications were examined from the reconstructed 3D μCT images, and a new grading system was developed. To validate the grading system, meniscal calcification volumes (CVM) were quantitatively analyzed and compared between the calcification grades. Furthermore, we estimated the relationship between histopathological degeneration and the calcification severity.

Results: 3D μCT images depict calcifications in every sample, including diminutive calcifications that are not visible in histology. In the new grading system, starting from grade 2, each grade results in a CVM that is 20.3 times higher (95% CI 13.3–30.5) than in the previous grade. However, there was no apparent difference in CVM between grades 1 and 2. The calcification grades appear to increase with the increasing histopathological degeneration, although histopathological degeneration is also observed with small calcification grades

Conclusions: 3D μCT grading of meniscal calcifications is feasible. Interestingly, it seems that there are two patterns of degeneration in the menisci of our sample set: 1) with diminutive calcifications (calcification grades 1–2), and 2) with large to widespread calcifications (calcification grades 3–5).

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Series: Osteoarthritis and cartilage
ISSN: 1063-4584
ISSN-E: 1522-9653
ISSN-L: 1063-4584
Volume: 31
Issue: 4
Pages: 482 - 492
DOI: 10.1016/j.joca.2022.10.016
Type of Publication: A1 Journal article – refereed
Field of Science: 217 Medical engineering
3121 General medicine, internal medicine and other clinical medicine
Funding: This project has received funding from the Foundation for Research in Rheumatology (FOREUM) (018EnglundPreCl), the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement No 771121), The Swedish Research Council, Governmental funding of clinical research within the national health services (ALF), The Swedish Rheumatism Association, Österlund Foundation, and Sigrid Jusélius Foundation. IH has received grants from Finnish Foundation for Technology Promotion (Grant No. 6562), and Instrumentarium Science Foundation (Grant No. 210036).
Copyright information: © 2022 The Author(s). Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International. This is an open access article under the CC BY license (