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The blood supply of early, late, and nonossifying cartilage: preliminary gray-scale and Doppler assessment and their implications

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Abstract

Background

Comparative gray-scale Doppler US studies of various cartilages have not been reported before.

Objective

To study gray-scale US and perfusion patterns of different cartilages.

Materials and methods

Three groups of cartilages were studied in 42 normal neonates. Group A included the proximal femoral chondroepiphysis of 20 neonates as well as proximal humeral, distal femoral, and proximal tibial epiphyses of 8 others. Group B included the patellar cartilage of nine neonates and group C included the rib cartilage of five neonates.

Results

Early ossifying cartilages all had numerous echogenic columns on US. Late ossifying patellar cartilage was amorphous and hypoechoic at birth but contained echogenic columns near the ossification age. Rib cartilage was hypoechoic and amorphous at all ages. The blood supply was detectable in all cartilages except the ribs. Peak systolic velocities increased with age in the proximal femoral epiphysis. The patellar cartilage was less vascular than the distal femoral epiphysis at birth, but more vascular at 14–24 months of age. The rib cartilage did not have any discernable blood supply at any age.

Conclusions

Cartilage blood flow is detectable with current technology. Cartilage blood flow correlates with the timing of its ossification. Normal cartilage blood flow may prognosticate normality of its growth and development potential.

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References

  1. Graf R (1980) The diagnosis of congenital hip joint dislocation by the ultrasonic compound treatment. Arch Orthop Trauma Surg 97:117–133

    Article  PubMed  CAS  Google Scholar 

  2. Novick G, Ghelman B, Schneider M (1983) Sonography of the neonatal and infant hip. AJR 141:639–645

    PubMed  CAS  Google Scholar 

  3. Harcke HT, Clarke NM, Lee MS et al (1984) Examination of the infant hip with real-time ultrasonography. J Ultrasound Med 3:131–137

    PubMed  CAS  Google Scholar 

  4. Boal DK, Schwentker EP (1991) Assessment of congenital hip dislocation with real-time ultrasound: a pictorial essay. Clin Imaging 15:77–90

    Article  PubMed  CAS  Google Scholar 

  5. Keller MS, Chawla HS, Weiss AA (1986) Real-time sonography of infant hip dislocation. Radiographics 6:447–456

    PubMed  CAS  Google Scholar 

  6. Yousefzadeh DK, Cooperman DR, Ramilo JL et al (1985) Computed sonography of septic hip (abstract). Presented at the Society for Pediatric Radiology annual meeting. Pediatr Radiol 15:437

    Google Scholar 

  7. Yousefzadeh DK, Ramilo JL (1987) Normal hip in children: correlation of US with anatomic and cryomicrotome sections. Radiology 165:647–655

    PubMed  CAS  Google Scholar 

  8. Barlow TG (1963) Early diagnosis and treatment of congenital dislocation of the hip. Proc R Soc Med 56:804–806

    PubMed  CAS  Google Scholar 

  9. Grissom LE, Harcke HT, Kumar SJ et al (1988) Ultrasound evaluation of hip position in the Pavlik harness. J Ultrasound Med 7:1–6

    PubMed  CAS  Google Scholar 

  10. Keller MS, Weiss AA (1988) Sonographic guidance for infant hip reduction under anesthesia. Pediatr Radiol 18:174–175

    Article  PubMed  CAS  Google Scholar 

  11. Clarke NM, Clegg J, Al-Chalabi AN (1989) Ultrasound screening of hips at risk from CDH. Failure to reduce the incidence of late cases. J Bone Joint Surg Br 71:9–12

    PubMed  CAS  Google Scholar 

  12. Harcke HT, Grissom LE (1994) Infant hip sonography: current concepts. Semin Ultrasound CT MR 15:256–263

    Article  PubMed  CAS  Google Scholar 

  13. Keller MS (1996) Sonographic detection of femoral head vascularity in neonates. Radiology 200:28–29

    PubMed  CAS  Google Scholar 

  14. Boal DK, Segal LS, Borthwick L (1994) Role of established femoral head vascularity in the management of developmental dysplasia of the hip. Presented at the 37th Annual Meeting of the Society for Pediatric Radiology, Colorado Springs, CO

  15. Bearcroft PW, Berman LH, Robinson AH et al (1996) Vascularity of the neonatal femoral head: in vivo demonstration with power Doppler US. Radiology 200:209–211

    PubMed  CAS  Google Scholar 

  16. Yousefzadeh DK, Sullivan C, Doerger K et al (1996) Doppler evaluation of perfusion of femoral head cartilage after abduction of dislocation hip (abstract). Radiological Society of North America Scientific Program, p 348

  17. Schwartz DS, Keller MS, Fields JM et al (1998) Arterial waveforms in the femoral head of healthy neonates. AJR 170:465–466

    PubMed  CAS  Google Scholar 

  18. Trueta J (1957) The normal vascular anatomy of the human femoral head. J Bone Joint Surg Br 39-B:358–394

    PubMed  CAS  Google Scholar 

  19. Trueta J (1968) Studies of the development and decay of the human frame. Saunders, Philadelphia, pp 80–138

    Google Scholar 

  20. Ogden JA (1982) Normal and abnormal circulation. In: Tachdjian MO (ed) Congenital dislocation of the hip. Churchill Livingstone, New York, pp 59–92

    Google Scholar 

  21. Wilsman NJ, Van Sickle DC (1972) Cartilage canals, their morphology and distribution. Anat Rec 173:79–93

    Article  PubMed  CAS  Google Scholar 

  22. Gruber HE, Lachman RS, Rimoin DL (1990) Quantitative histology of cartilage vascular canals in the human rib. Findings in normal neonates and children and in achondrogenesis II–hypochondrogenesis. J Anat 173:69–75

    PubMed  CAS  Google Scholar 

  23. Jaramillo D, Villegas-Medina OL, Doty DK et al (2004) Age-related vascular changes in the epiphysis, physis, and metaphysis: normal findings on gadolinium-enhanced MRI of piglets. AJR 182:353–360

    PubMed  Google Scholar 

  24. Varich LJ, Laor T, Jaramillo D (2000) Normal maturation of the distal femoral epiphyseal cartilage: age-related changes at MR imaging. Radiology 214:705–709

    PubMed  CAS  Google Scholar 

  25. Barnewolt CE, Shapiro F, Jaramillo D (1997) Normal gadolinium enhanced MR images of developing appendicular skeleton. Part I. Cartilagenous epiphysis and physis. AJR 169:183–189

    PubMed  CAS  Google Scholar 

  26. Earley A, Fayers P, Ng S et al (1980) Blood pressure in the first 6 weeks of life. Arch Dis Child 55:755–757

    Article  PubMed  CAS  Google Scholar 

  27. Girdany BR, Osman MZ (1968) Longitudinal growth and skeletal maturation in Perthes’ disease. Radiol Clin North Am 6:245–251

    PubMed  CAS  Google Scholar 

  28. Laor T, Jaramillo D, Oestreich AE (1998) Musculoskeletal system. In: Kirks DR, Griscom NT (eds) Practical pediatric imaging: diagnostic radiology of infants and children. Lippincott-Raven, Philadelphia, p 327–510

    Google Scholar 

  29. Mackenzie WG, Bassett GS, Mandell GA et al (1989) Avascular necrosis of the hip in multiple epiphyseal dysplasia. J Pediatr Orthop 9:666–671

    PubMed  CAS  Google Scholar 

  30. Dunbar JD, Sussman MD, Aiona MD (1995) Hip pathology in the trichorhinophalangeal syndrome. J Pediatr Orthop 15:381–385

    PubMed  CAS  Google Scholar 

  31. Minguella I, Ubierna M, Escola J et al (1993) Trichorhinophalangeal syndrome, type I, with avascular necrosis of the femoral head. Acta Paediatr 82:329–330

    PubMed  CAS  Google Scholar 

  32. Daudet M, David M, Aimard P (1986) Lesions of the hip in congenital myxedema in children. Chir Pediatr 27:94–99

    PubMed  CAS  Google Scholar 

  33. Roy DR (1991) Perthes’-like changes caused by acquired hypothyroidism. Orthopedics 14:901–904

    PubMed  CAS  Google Scholar 

  34. Gustafson T, Sunden O (1985) Intracapsular pressure in transient synovitis of the hip. Acta Orthop Scand 56:204–210

    Article  PubMed  Google Scholar 

  35. Wingstrand H (1999) Significance of synovitis in Legg-Calvé-Perthes disease. J Pediatr Orthop B 8:156–160

    PubMed  CAS  Google Scholar 

  36. Vegter J (1987) The influence of joint posture on intra-articular pressure. A study of transient synovitis and Perthes’ disease. J Bone Joint Surg Br 69:71–74

    PubMed  CAS  Google Scholar 

  37. Keenan WN, Clegg J (1996) Perthes’ disease after “irritable hip”: delayed bone age shows that hip is a “marked man”. J Pediatr Orthop 16:20–23

    PubMed  CAS  Google Scholar 

  38. Gordon JE, Schoenecker PL, Osland JD et al (2004) Smoking and socio-economic status in the etiology and severity of Legg-Calve-Perthes’ disease. J Pediatr Orthop B 13:367–370

    PubMed  Google Scholar 

  39. Mata SG, Aicua EA, Ovejero AH et al (2000) Legg-Calve-Perthes disease and passive smoking. J Pediatr Orthop 20:326–330

    Article  PubMed  CAS  Google Scholar 

  40. Glueck CJ, Freiberg RA, Crawford A et al (1998) Secondhand smoke, hypofibrinolysis, and Legg-Perthes disease. Clin Orthop Relat Res 352:159–167

    Article  PubMed  Google Scholar 

  41. Jaramillo D, Villegas-Medina O, Laor T et al (1998) Gadolinium-enhanced MR imaging of pediatric patients after reduction of dysplastic hips: assessment of femoral head position, factors impeding reduction, and femoral head ischemia. AJR 170:1633–1637

    PubMed  CAS  Google Scholar 

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Correspondence to D. K. Yousefzadeh.

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Yousefzadeh, D.K., Doerger, K. & Sullivan, C. The blood supply of early, late, and nonossifying cartilage: preliminary gray-scale and Doppler assessment and their implications. Pediatr Radiol 38, 146–158 (2008). https://doi.org/10.1007/s00247-007-0655-2

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  • DOI: https://doi.org/10.1007/s00247-007-0655-2

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