Key DFM Personnel

  • David Rabago, MD – Principal Investigator
  • Jeffrey Patterson, DO Prolotherapist
  • Jessica Grettie, Research Specialist, is the Study Coordinator
  • Richard Kijowski, MD and Dr. Walter Block, Ph.D. Co-Investigators

Funding

UW Medical Education and Research Committee

Background

Knee osteoarthritis (OA) is a common, painful, debilitating, age-related condition with enormous clinical importance to patients in Wisconsin and worldwide. Magnetic resonance (MR) imaging is recognized as the optimal imaging modality of the osteoarthritic knee in Phase 2 clinical trials investigating potentially disease-modifying therapy for knee OA. However, MR assessment of the entire knee can take up to 1 hour, limiting its application. Prolotherapy (PrT) is an injection-based therapy for knee OA that is reported to decrease pain and modify disease by promoting improved strength and biomechanical integrity of ligament and tendon attachments and intra-articular collagenous structures.

Goal

The goal of this study is to assess changes in anatomic structures associated with knee OA using two MR protocols for whole organ knee evaluation, a standard MR protocol and the much faster “vastly undersampled isotropic projection reconstruction” (VIPR) MR pulse sequence. The current proposal adds both of these MR imaging protocols to the outcome assessment strategy of an ongoing Wisconsin-based RCT of PrT, (“The efficacy of prolotherapy for osteoarthritic knee pain”)

Methods

Pre- and post treatment MR evaluation will be added to the outcome assessment strategy of 42 subjects to be enrolled in the parent RCT using a protocol consistent with recent guidelines calling for evaluation of the knee as 1) a “whole organ” and 2) as individual tissue structures. The primary outcome will be a blinded score on the Whole Organ Magnetic Resonance (WORM) scale; WORM scores obtained using the 5-minute VIPR sequence will be compared to WORM scores obtained using a one-hour MR protocol to determine whether both methods can provide similar assessment of the osteoarthritic knee. Secondary outcomes will include blinded quantitative assessment of individual structures related to knee OA severity including knee synovium, synovial fluid, bone marrow edema and cartilage volume.

Significance

Positive outcomes would suggest that PrT has pain-control and disease-modifying effects, providing strong preliminary evidence for PrT as a primary treatment of knee OA improving the quality of life of Wisconsin knee OA patients. The ability of the VIPR sequence to provide similar “whole-organ” knee assessment compared to currently used MR protocols would provide faster, less expensive MR evaluation, decreasing the burden of OA assessment and treatment on Wisconsin patients and the Wisconsin health care system.

The project is an interdisciplinary collaboration between the UW Departments of Family Medicine, Radiology, Medical Physics, and Bioengineering on basic and clinical science levels. The project will use new technology developed by researchers in the Medical Physics and Bioengineering Departments and applied to clinical patient imaging by researchers in the Radiology Department.