Altered cartilage mechanics and histology in knee osteoarthritis: relation to clinical assessment (ICRS Grade).

OBJECTIVE: Substantial changes in articular cartilage composition and mechanical properties occur during the development of osteoarthritis (OA). While softening in the initial stage is reported and sometimes used as an indicator of early OA, there is a lack of data relating the macroscopic appearance of cartilage to its mechanical and histological properties in all stages of degeneration. Knowledge about the mechanical quality of the tissue is important for diagnostic reasons and the understanding of the development of OA.
DESIGN: The cartilage areas of 21 osteoarthritic human cadaver tibia plateaus were classified using the International Cartilage Repair Society (ICRS) system. A material testing device determined the Young's modulus of the cartilage by unconfined compression. Histological analysis used haematoxylin and eosin staining and Safranin-O staining for the evaluation of the Mankin score.
RESULTS: A correlation between increasing ICRS Grade and stiffness reduction was found (R2=0.69). Stiffness values were for ICRS Grades 1, 2 and 3: E1=0.50+/-0.14 MPa, E2=0.37+/-0.13 MPa and E3=0.28+/-0.12 MPa, respectively. The histological evaluation confirmed the ICRS classification (R2=0.74). A moderate correlation between Mankin score and cartilage stiffness was observed (R2=0.47).
CONCLUSIONS: The results indicate a relation between structural, mechanical and histological changes in all stages of the degeneration. With increasing ICRS Grade the cartilage stiffness, which is primarily influenced by the integrity of the extracellular matrix, decreases. Therefore, methods of stiffness determination such as indentation may be used to characterize cartilage in all stages of OA. However, the data suggest that differentiating between healthy cartilage and ICRS Grade 1 may be difficult using mechanical testing alone.