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Journal of Chinese Integrative Medicine ›› 2009, Vol. 7 ›› Issue (2): 110-115.doi: 10.3736/jcim20090203

• Original Clinical Research • Previous Articles     Next Articles

Application of magnetic resonance imaging in evaluating the effects of manipulation on knee osteoarthritis

 Jiong Hua, Ning Dub, Yong Lua, Ling-hui Daia   

  1. a Department of Traumatology, Ruijin Hospital, Medical College of Shanghai Jiaotong University, Shanghai 200025, China
    b Shanghai Pain Care Hospital, Shanghai 200025, China
  • Received:2008-08-28 Accepted:2008-10-20 Online:2009-02-20 Published:2009-02-15


To observe and evaluate the effects of manipulation on knee osteoarthritis (KOA) using T2-mapping and magnetic resonance imaging (MRI)-based volume measurements.

Forty-five cases of KOA were involved retrospectively in the study, and the patients were composed of 9 males and 36 females with the mean age of (57.4±6.1) years. The cases were treated with manipulative therapy once or twice per week for 12 months. MRI of each knee was performed separately by using 1.5-T MRI equipment before and during the treatment. Average cartilage depth, MRI grading of cartilage defects, cartilage volume, average T2 values in patella cartilage and femoral condyle, and bone marrow edema area were detected respectively.

The knee joint cartilage thickness from MRI began to increase after 6-month treatment (P<0.05). The cartilage volume increase was obviously observed after 12-month treatment, and there was a significant difference (F=14.64, P<0.01). MRI grading of cartilage defects decreased from ⅢA to ⅡB after 3-month treatment (Z=17.96, P<0.05). The average T2 value in patella cartilage decreased after 9-month treatment (F=3.11, P<0.05), but there were no differences in cartilage from tibial plateau and femoral condyle compartments after the treatment. The bone marrow edema area in femoral condyle began to diminish at 3-month treatment (t=–4.53, P<0.01), and the bone marrow edema area in cartilage patella was diminished after 6-month treatment (t=–5.53, P<0.01).

T2-mapping and cartilage volume measurement are suitable for evaluating the manipulative therapy on KOA. Traditional Chinese manipulation therapy is an effective method for KOA in the cartilage recovery.

Key words: Knee joint, Osteoarthritis, Musculoskeletal manipulations, Nuclear magnetic resonance

Table 1

Changes of MRI parameters before and after treatment (x±s)"

Treatment time n MRI parameters
volume (cm3)
MRI grading
of cartilage
Average T2
value in patella
cartilage (ms)
Average T2
value in femoral
condyle (ms)
Bone marrow
edema area in femur
cartilage (cm2)
Bone marrow edema
area in patella
cartilage (cm2)
Before treatment 45 96.76±12.99 3.80±0.91 36.42±3.01 36.14±3.56 5.80±0.93 3.96±0.82
Three months 45 98.18±14.48 3.34±0.86* 35.82±3.38 36.86±3.19 4.08±3.70* 3.46±0.34
Six months 45 104.36±11.24 3.28±0.98* 35.70±2.90 35.95±1.18 3.22±0.56* 2.01±0.11*
Nine months 45 109.32±13.45 3.15±0.78* 32.18±2.37* 35.69±2.44 2.95±0.37* 1.92±0.76*
Twelve months 45 122.06±29.80* 3.12±0.97* 31.77±2.33* 35.46±1.17 2.63±0.65* 1.55±0.85*

Figure 1

Changes of MRI cartilage volume before and after treatment A: Before treatment; B: Three-month treatment; C: Six-month treatment; D: Nine-month treatment; E: Twelve-month treatment."

Figure 2

Changes of MRI cartilage volume before and after treatment A: Before treatment; B: Three-month treatment; C: Six-month treatment; D: Nine-month treatment; E: Twelve-month treatment."

Figure 3

Changes of bone marrow edema before and after treatment A: Before treatment; B: Three-month treatment; C: Six-month treatment. White arrowhead demonstrated the location of bone marrow edema in patella. After 6-month treatment the areas of bone marrow edema obviously diminished or disappeared."

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