New approaches to the management of musculoskeletal disease using Optical Coherence Tomography (OCT)

Imaging modalities such as MRI, CT, and ultrasound are critical to managing the patient with musculoskeletal disease. However, a need still exists for assessing many pathologic states at higher resolutions, near that of histology. This is particularly critical for early pathology of bone, cartilage, and tendon, as they are generally not readily amenable to biopsy. Specific pathophysiologies where this level of resolution is needed includes early osteoarthritis (OA), tendon disorders (particularly rotator cuff repairs, RCR), and rheumatoid arthritis (RA). Optical coherence tomography (OCT) is a micron scale imaging technology which is now in widespread use in ophthalmology and cardiology [1,2]. This papers looks at the role of OCT in musculoskeletal disorders.

This paper is organized in the following manner: first, we briefly review the technology, which is discussed in depth in other places. In the next section, we focus on the use of OCT in early OA, which is perhaps its most important application in orthopedics. In the third section, we discuss its role in rotator cuff repair, where we feel at this stage its ability to monitor the study of fibrocartilage regeneration will have the biggest impact. Once therapeutics have been established to augment rotator cuff repair, then we foresee its transition to direct patient care. The fourth section deals with its role in RA management.  Here, a need exists for identifying the subset of early destructive disease for aggressive therapy, an objective not achievable with current imaging modalities. In addition to patient management, it has demonstrated feasibility for rheumatoid animal research work in both understanding pathophysiology and therapeutics. 

By Dr Christopher Vercollone, Dr Scott Martin, Dr Bin Liu, & Dr Mark E Brezinski

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