Combined high-resolution magnetic resonance imaging and histology to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis

Ai Lyn Tan ¹, Hechmi Toumi ², Michael Benjamin ², Andrew J Grainger ³, Steven F Tanner ¹, Paul Emery ¹ and Dennis McGonagle ^1*

¹ University of Leeds, United Kingdom
² Cardiff University, United Kingdom
³ Chapel Allerton Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: d.g.mcgonagle{at}leeds.ac.uk.

Accepted 10 April 2006

Abstract

Objective: The pathogenesis of the early stages of hand osteoarthritis (OA) is poorly understood, but recent high-resolution magnetic resonance imaging (hrMRI) studies suggest that the joint ligaments play a major role in the phenotypic expression of the disease. The purpose of this study was to combine hrMRI and cadaveric histological studies to better understand the mechanisms of damage and especially the role of joint ligaments and tendons in disease expression.

Methods: High-resolution MRI was performed in the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints in 20 subjects with OA of disease duration of 12 months or less. Histological sections of the PIP joints were obtained from 3 dissecting room specimens for comparative analysis.

Results: The collateral ligaments influenced the location of both hrMRI determined bone oedema and bone erosion in early OA. These changes were best understood in relationship to the enthesis organ concept whereby the interaction between ligament fibrocartilages leads to bone disease. Normal ligaments were commonly associated with microdamage at insertions corresponding to ligament thickening noted in early OA. The ligaments also influenced the location of node formation in early OA. Finally the DIP extensor tendon insertions were associated with the development of a neoarticular surface.

Conclusions: Small joint collateral ligaments and tendons play a central role in the early stages of hand OA, and determine the early expression of both the soft tissue and bony changes in disease.

Keywords: histology, ligaments, magnetic resonance imaging, osteoarthritis, tendons

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