Potential enhancement of articular cartilage histological grading with collagen integrity.

BACKGROUND: Histological evaluation of articular cartilage, such as using the Mankin scoring system, is the gold standard for characterization of tissue integrity. This scoring system takes into account several parameters indicative of the tissue's health; however, the collagen integrity, which is a primary indicator of cartilage health is not taken into consideration. Thus, there is need to enhance histological grading of articular cartilage by incorporating explicit scoring of collagen degeneration into the Modified Mankin grading system. This paper explores a new histological grading parameter for collagen network degradation and how this information can be used to augment a widely used grading scheme like the Modified Mankin grading system.

METHODS: Intact and degenerated human cartilage were examined histologically and then subjected to second harmonic generation imaging, leading to qualitative and quantitative description of collagen disruption emanating from the surface to subsurface layers of the tissue. This data was then incorporated into the Modified Mankin grading system.

FINDINGS: Second harmonic generation image analysis reveals a relationship between changes in collagen architecture and histologically observed tissue disruption in degenerated articular cartilage.

INTERPRETATION: Histological tissue disruption in degenerated human articular cartilage is directly related to the reorganization of collagen fibrils in the form of intense fibril aggregation, either as a result of degeneration or aging. This method of mapping disrupted tissue regions to quantitative collagen fibril damage can be coded into cartilage grading systems and could inform clinical practice and scientific research.