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Changhai Ding - One of the best experts on this subject based on the ideXlab platform.

  • quantitative signal intensity alteration in Infrapatellar Fat Pad predicts incident radiographic osteoarthritis the osteoarthritis initiative
    Arthritis Care and Research, 2019
    Co-Authors: Kang Wang, Changhai Ding, M J Hannon, Zhongshan Chen, Kent C Kwoh, David J Hunter
    Abstract:

    OBJECTIVE To determine whether Infrapatellar Fat Pad (IPFP) signal intensity measures are predictive of incident radiographic osteoarthritis (ROA) over 4 years in the Osteoarthritis Initiative study. METHODS Case knees (n = 355), as defined by incident ROA, were matched 1:1 with control knees, according to sex, age, and radiographic status. T2-weighted magnetic resonance images were assessed at P0 (the visit when incident ROA was observed on a radiograph), P1 (1 year prior to P0), and baseline and used to assess IPFP signal intensity semiautomatically. Conditional logistic regression analyses were performed to assess the risk of incident ROA associated with IPFP signal intensity alteration, after adjustment for covariates. RESULTS The mean age of the participants was 60.2 years, and most (66.7%) were female and overweight (mean body mass index 28.3 kg/m2 ). Baseline IPFP measures including the mean value and standard deviation of IPFP signal intensity, the mean value and standard deviation of IPFP high signal intensity, median and upper quartile values of IPFP high signal intensity, and the clustering effect of high signal intensity were associated with incident knee ROA over 4 years. All P1 IPFP measures were associated with incident ROA after 12 months. All P0 IPFP signal intensity measures were associated with ROA. CONCLUSION The quantitative segmentation of high signal intensity in the IPFP observed in our study confirms the findings of previous work based on semiquantitative assessment, suggesting the predictive validity of semiquantitative assessment of IPFP high signal intensity. The IPFP high signal intensity alteration could be an important imaging biomarker to predict the occurrence of ROA.

  • signal intensity alteration within Infrapatellar Fat Pad predicts knee replacement within 5 years data from the osteoarthritis initiative
    Osteoarthritis and Cartilage, 2018
    Co-Authors: Z Chen, Changhai Ding, Kang Wang, M J Hannon, C K Kwoh, J A Lynch, David J Hunter
    Abstract:

    Summary Objective To investigate whether Infrapatellar Fat Pad (IPFP) signal intensity (SI) alteration predicts the occurrence of knee replacement (KR) in knee osteoarthritis (OA) patients over 5 years. Design The subjects were selected from Osteoarthritis Initiative (OAI) study. Case knees (n = 127) were defined as those who received KR during 5 years follow-up visit. They were matched by gender, age and radiographic status with control knees (n = 127). We used T2-weighted MR images to measure IPFP SI alteration using a newly developed algorithm in MATLAB. The measurements were assessed at baseline (BL), T0 (the visit just before KR) and 1 year before T0 (T-1). Conditional logistic regression was used to analyse the associations between IPFP SI alterations and the risk of KR. Results Participants were mostly female (57%), with an average age of 63.7 years old and a mean body mass index (BMI) of 29.5 kg/m2. In multivariable analysis, the standard deviation (SD) of IPFP SI [sDev (IPFP)] and the ratio of high SI region volume to whole IPFP volume [Percentage (H)] measured at BL were significantly associated with increased risks of KR after adjustment for covariates. IPFP SI alterations measured at T-1 including sDev (IPFP), Percentage (H) and clustering effect of high SI [Clustering factor (H)] were significantly associated with higher risks of KR. All measurements were significantly associated with higher risks of KR at T0. Conclusions IPFP SI is associated with the occurrence of KR suggesting it may play a role in end-stage knee OA.

  • a novel method for assessing signal intensity within Infrapatellar Fat Pad on mr images in patients with knee osteoarthritis
    Osteoarthritis and Cartilage, 2016
    Co-Authors: Z Chen, Weiyu Han, Z Zhu, Xingzhong Jin, David J Hunter, Changhai Ding
    Abstract:

    Summary Purpose To assess reliability and validity of a semi-automated quantitative method to measure Infrapatellar Fat Pad (IPFP) signal intensity in patients with knee osteoarthritis (OA). Methods Hundred patients with knee OA were selected. Sagittal planes of Fat-saturated T2-weighted images obtained on 1.5-T magnetic resonance imaging (MRI) were utilized to assess IPFP signal intensity using MATLAB. Knee structural abnormalities including cartilage defects, bone marrow lesions (BML) and radiographic OA (ROA) were evaluated. Clinical construct validity and concurrent validity were examined through describing associations of IPFP measurements with knee structural abnormalities and a semi-quantitative scoring method, respectively. The reliability was examined by calculating the intra- and inter-observer correlation coefficients. Results Significantly positive associations were found between standard deviation of IPFP signal intensity [sDev (IPFP)], clustering factor (H) and all knee structural abnormalities. The volume of high signal intensity regions [Volume (H)] and the ratio of Volume (H) to volume of whole IPFP [Percentage (H)] were positively associated with cartilage defects and ROA, but not with BMLs. The median value [Median (H)] and upper quartile value [UQ (H)] of high signal intensity were only significantly associated with quartiles of cartilage defect score. Significant correlations were found between all quantitative measurements and semi-quantitative scores (All P 0.90). Conclusions A novel and efficient method to segment IPFP and calculate its signal intensity on T2-weighted MRI images is documented. This method is reproducible, and has concurrent and clinical construct validity, but its predictive validity needs to be examined by future longitudinal studies.

  • response to the role of Infrapatellar Fat Pad resection in total knee arthroplasty by white et al
    Annals of the Rheumatic Diseases, 2016
    Co-Authors: W Han, Z Zhu, Zhenhua Liu, Xia Wang, Benny Antony, Faming Pan, Shuang Zheng, Changhai Ding
    Abstract:

    We thank White and Melhuish1 for their interest in our original paper2 and our response3 to Bai et al. 4 There is moderate level evidence in a recent systematic review showing that Infrapatellar Fat Pad (IPFP) preservation improves clinical outcomes post total knee arthroplasty (TKA), whereas IPFP resection increases post-TKA knee pain.5 This is contradictory with a previous systematic review suggesting that there were no differences in function, range of motion and anterior knee pain between preservation and resection groups after TKA in knee osteoarthritis (OA).6 This new evidence is consistent with our findings that the IPFP maximal area was associated with reduced …

  • response to Infrapatellar Fat Pad maximal area and changes in knee symptoms gender related difference or gender difference in reporting by bai et al
    Annals of the Rheumatic Diseases, 2016
    Co-Authors: Faming Pan, Xingzhong Jin, Zhenhua Liu, Xia Wang, Benny Antony, W Han, Flavia M Cicuttini, Graeme Jones, Changhai Ding
    Abstract:

    We would like to thank Bai et al for their interest in and comments on our paper titled ‘A longitudinal study of the association between Infrapatellar Fat Pad maximal area and changes in knee symptoms and structure in older adults’.1 First, we agree that the overall response rate was not high (57%). We identified the participants randomly from the local community using the electoral roll, and the reasons for not participating in this study were not being eligible, not being contactable and refusing to participate. The response rate is comparable to those (52–58%) from studies with equivalent response burdens conducted around the same time period.2 ,3 The moderate response rate can be offset by the high rate of retention at follow-up. Bai et al assumed that people with pain to start with were more likely to respond, and those with significant changes in pain symptoms over …

Daniel J Kelly - One of the best experts on this subject based on the ideXlab platform.

  • Infrapatellar Fat Pad stem cells from developmental biology to cell therapy
    Stem Cells International, 2017
    Co-Authors: Ronaldo Jose Farias Correa Do Amaral, Henrique V Almeida, Daniel J Kelly, Fergal J Obrien, Cathal J Kearney
    Abstract:

    The ideal cell type to be used for cartilage therapy should possess a proven chondrogenic capacity, not cause donor-site morbidity, and should be readily expandable in culture without losing their phenotype. There are several cell sources being investigated to promote cartilage regeneration: mature articular chondrocytes, chondrocyte progenitors, and various stem cells. Most recently, stem cells isolated from joint tissue, such as chondrogenic stem/progenitors from cartilage itself, synovial fluid, synovial membrane, and Infrapatellar Fat Pad (IFP) have gained great attention due to their increased chondrogenic capacity over the bone marrow and subcutaneous adipose-derived stem cells. In this review, we first describe the IFP anatomy and compare and contrast it with other adipose tissues, with a particular focus on the embryological and developmental aspects of the tissue. We then discuss the recent advances in IFP stem cells for regenerative medicine. We compare their properties with other stem cell types and discuss an ontogeny relationship with other joint cells and their role on in vivo cartilage repair. We conclude with a perspective for future clinical trials using IFP stem cells.

  • Infrapatellar Fat Pad derived stem cells maintain their chondrogenic capacity in disease and can be used to engineer cartilaginous grafts of clinically relevant dimensions
    Tissue Engineering Part A, 2014
    Co-Authors: Yurong Liu, Henrique V Almeida, Conor T Buckley, Kevin J Mulhall, Daniel J Kelly
    Abstract:

    A therapy for regenerating large cartilaginous lesions within the articular surface of osteoarthritic joints remains elusive. While tissue engineering strategies such as matrix-assisted autologous chondrocyte implantation can be used in the repair of focal cartilage defects, extending such approaches to the treatment of osteoarthritis will require a number of scientific and technical challenges to be overcome. These include the identification of an abundant source of chondroprogenitor cells that maintain their chondrogenic capacity in disease, as well as the development of novel approaches to engineer scalable cartilaginous grafts that could be used to resurface large areas of damaged joints. In this study, it is first demonstrated that Infrapatellar Fat Pad-derived stem cells (FPSCs) isolated from osteoarthritic (OA) donors possess a comparable chondrogenic capacity to FPSCs isolated from patients undergoing ligament reconstruction. In a further validation of their functionality, we also demonstrate that...

  • combining freshly isolated chondroprogenitor cells from the Infrapatellar Fat Pad with a growth factor delivery hydrogel as a putative single stage therapy for articular cartilage repair
    Tissue Engineering Part A, 2014
    Co-Authors: Mark Ahearne, Yurong Liu, Daniel J Kelly
    Abstract:

    Growth factor delivery systems incorporating chondroprogenitor cells are an attractive potential treatment option for damaged cartilage. The rapid isolation, processing, and implantation of therapeutically relevant numbers of autologous chondroprogenitor cells, all performed “in-theatre” during a single surgical procedure, would significantly accelerate the clinical translation of such tissue engineered implants by avoiding the time, financial and regulatory challenges associated with in vitro cell expansion, and differentiation. The first objective of this study was to explore if rapid adherence to a specific substrate could be used as a simple means to quickly identify a subpopulation of chondroprogenitor cells from freshly digested Infrapatellar Fat Pad (IFP) tissue. Adhesion of cells to tissue culture plastic within 30 min was examined as a mechanism of isolating subpopulations of cells from the freshly digested IFP. CD90, a cell surface marker associated with cell adhesion, was found to be more highl...

  • composition function relations of cartilaginous tissues engineered from chondrocytes and mesenchymal stem cells isolated from bone marrow and Infrapatellar Fat Pad
    Journal of Tissue Engineering and Regenerative Medicine, 2011
    Co-Authors: Tatiana Vinardell, Conor T Buckley, Stephen D Thorpe, Daniel J Kelly
    Abstract:

    The objective of this study was to determine the functional properties of cartilaginous tissues generated by porcine MSCs isolated from different tissue sources, and to compare these properties to those derived from chondrocytes (CCs). MSCs were isolated from bone marrow (BM) and Infrapatellar Fat Pad (FP), while CCs were harvested from the articular surface of the femoro-patellar joint. Culture-expanded CCs and MSCs were encapsulated in agarose hydrogels and cultured in the presence of TGFβ3. Samples were analysed biomechanically, biochemically and histologically at days 0, 21 and 42. After 42 days in free swelling culture, mean GAG content was 1.50% w/w in CC-seeded constructs, compared to 0.95% w/w in FP- and 0.43% w/w in BM-seeded constructs. Total collagen accumulation was highest in FP constructs. DNA content increased with time for all the groups. The mechanical functionality of cartilaginous tissues engineered using CCs was superior to that generated from either source of MSCs. Differences were also observed in the spatial distribution of matrix components in tissues engineered using CCs and MSCs, which appears to have a strong influence on the apparent mechanical properties of the constructs. Therefore, while functional cartilaginous tissues can be engineered using MSCs isolated from different sources, the spatial composition of these tissues is unlike that generated using chondrocytes, suggesting that MSCs and chondrocytes respond differently to the regulatory factors present within developing cartilaginous constructs. Copyright © 2010 John Wiley & Sons, Ltd.

  • functional properties of cartilaginous tissues engineered from Infrapatellar Fat Pad derived mesenchymal stem cells
    Journal of Biomechanics, 2010
    Co-Authors: Conor T Buckley, Tatiana Vinardell, Stephen D Thorpe, Matthew G Haugh, Elena Jones, Dennis Mcgonagle, Daniel J Kelly
    Abstract:

    Abstract Articular cartilage has a poor intrinsic capacity for self-repair. The advent of autologous chondrocyte implantation has provided a feasible method to treat cartilage defects. However, the associated drawbacks with the isolation and expansion of chondrocytes from autologous tissue has prompted research into alternative cell sources such as mesenchymal stem cells (MSCs) which have been found to exist in the bone marrow as well as other joint tissues such as the Infrapatellar Fat Pad (IFP), synovium and within the synovial fluid itself. In this work we assessed the chondrogenic potential of IFP-derived porcine cells over a 6 week period in agarose hydrogel culture in terms of mechanical properties, biochemical content and histology. It was found that IFP cells underwent robust chondrogenesis as assessed by glycosaminoglycan (1.47±0.22% w/w) and collagen (1.44±0.22% w/w) accumulation after 42 days of culture. The 1 Hz dynamic modulus of the engineered tissue at this time point was 272.8 kPa (±46.8). The removal of TGF-β3 from culture after 21 days was shown to have a significant effect on both the mechanical properties and biochemical content of IFP constructs after 42 days, with minimal increases occurring from day 21 to day 42 without continued supplementation of TGF-β3. These findings further strengthen the case that the IFP may be a promising cell source for putative cartilage repair strategies.

Hari A Reddi - One of the best experts on this subject based on the ideXlab platform.

  • mesenchymal progenitor cells derived from synovium and Infrapatellar Fat Pad as a source for superficial zone cartilage tissue engineering analysis of superficial zone protein lubricin expression
    Tissue Engineering Part A, 2010
    Co-Authors: Toshiyuki Nakagawa, Hari A Reddi
    Abstract:

    Superficial zone protein (SZP) is a boundary lubricant of articular cartilage in joints. As SZP at the surface of articular cartilage plays an important role in the normal function of synovial joints, the localization of SZP-secreting cells at the surface of tissue-engineered cartilage is prerequisite. The aim of this study was to identify suitable progenitor cell sources for tissue engineering of superficial zone cartilage. We investigated whether mesenchymal progenitor cells (MPCs) from synovium and Infrapatellar Fat Pad (IFP) have the potential for secretion of SZP after chondrogenic differentiation in an aggregate pellet culture system. SZP was immunolocalized in pellets from synovium-MPCs and IFP-MPCs. The enzyme-linked immunosorbent assay analysis of SZP demonstrated that chondrogenically differentiated synovium-MPC and IFP-MPC pellets secreted SZP into media. Real-time polymerase chain reaction analysis showed significant upregulation of SZP mRNA in synovium-MPC and IFP-MPC pellets after chondrogen...

  • induction of chondrogenesis and expression of superficial zone protein szp lubricin by mesenchymal progenitors in the Infrapatellar Fat Pad of the knee joint treated with tgf β1 and bmp 7
    Biochemical and Biophysical Research Communications, 2008
    Co-Authors: Sang Yang Lee, Toshiyuki Nakagawa, Hari A Reddi
    Abstract:

    Superficial zone protein (SZP) is a key mediator of boundary lubrication of articular cartilage in joints. In this investigation, we made the unexpected discovery that SZP was expressed in Infrapatellar Fat Pad (IFP) from bovine knee. Quantitative analysis of secreted proteins in the medium of the IFP stromal cells demonstrated a significant stimulation by TGF-beta1 and BMP-7. Real-time PCR analysis revealed the SZP expression was up-regulated by TGF-beta1 and BMP-7. Chondrogenically differentiated IFP progenitor cells were stimulated by TGF-beta1 and BMP-7 to synthesize and secrete SZP. SZP mRNA was significantly up-regulated by chondrogenic induction for 21 days. These findings indicate that the stimulation of SZP expression by TGF-beta and BMP-7 may lead to functional improvement of damaged intraarticular tissues and that IFP progenitor cells may be a potential useful source for inducing superficial zone of articular cartilage by tissue engineering for regeneration of damaged articular cartilage due to osteoarthritis.

Toshiyuki Nakagawa - One of the best experts on this subject based on the ideXlab platform.

  • mesenchymal progenitor cells derived from synovium and Infrapatellar Fat Pad as a source for superficial zone cartilage tissue engineering analysis of superficial zone protein lubricin expression
    Tissue Engineering Part A, 2010
    Co-Authors: Toshiyuki Nakagawa, Hari A Reddi
    Abstract:

    Superficial zone protein (SZP) is a boundary lubricant of articular cartilage in joints. As SZP at the surface of articular cartilage plays an important role in the normal function of synovial joints, the localization of SZP-secreting cells at the surface of tissue-engineered cartilage is prerequisite. The aim of this study was to identify suitable progenitor cell sources for tissue engineering of superficial zone cartilage. We investigated whether mesenchymal progenitor cells (MPCs) from synovium and Infrapatellar Fat Pad (IFP) have the potential for secretion of SZP after chondrogenic differentiation in an aggregate pellet culture system. SZP was immunolocalized in pellets from synovium-MPCs and IFP-MPCs. The enzyme-linked immunosorbent assay analysis of SZP demonstrated that chondrogenically differentiated synovium-MPC and IFP-MPC pellets secreted SZP into media. Real-time polymerase chain reaction analysis showed significant upregulation of SZP mRNA in synovium-MPC and IFP-MPC pellets after chondrogen...

  • induction of chondrogenesis and expression of superficial zone protein szp lubricin by mesenchymal progenitors in the Infrapatellar Fat Pad of the knee joint treated with tgf β1 and bmp 7
    Biochemical and Biophysical Research Communications, 2008
    Co-Authors: Sang Yang Lee, Toshiyuki Nakagawa, Hari A Reddi
    Abstract:

    Superficial zone protein (SZP) is a key mediator of boundary lubrication of articular cartilage in joints. In this investigation, we made the unexpected discovery that SZP was expressed in Infrapatellar Fat Pad (IFP) from bovine knee. Quantitative analysis of secreted proteins in the medium of the IFP stromal cells demonstrated a significant stimulation by TGF-beta1 and BMP-7. Real-time PCR analysis revealed the SZP expression was up-regulated by TGF-beta1 and BMP-7. Chondrogenically differentiated IFP progenitor cells were stimulated by TGF-beta1 and BMP-7 to synthesize and secrete SZP. SZP mRNA was significantly up-regulated by chondrogenic induction for 21 days. These findings indicate that the stimulation of SZP expression by TGF-beta and BMP-7 may lead to functional improvement of damaged intraarticular tissues and that IFP progenitor cells may be a potential useful source for inducing superficial zone of articular cartilage by tissue engineering for regeneration of damaged articular cartilage due to osteoarthritis.

W Han - One of the best experts on this subject based on the ideXlab platform.

  • response to the role of Infrapatellar Fat Pad resection in total knee arthroplasty by white et al
    Annals of the Rheumatic Diseases, 2016
    Co-Authors: W Han, Z Zhu, Zhenhua Liu, Xia Wang, Benny Antony, Faming Pan, Shuang Zheng, Changhai Ding
    Abstract:

    We thank White and Melhuish1 for their interest in our original paper2 and our response3 to Bai et al. 4 There is moderate level evidence in a recent systematic review showing that Infrapatellar Fat Pad (IPFP) preservation improves clinical outcomes post total knee arthroplasty (TKA), whereas IPFP resection increases post-TKA knee pain.5 This is contradictory with a previous systematic review suggesting that there were no differences in function, range of motion and anterior knee pain between preservation and resection groups after TKA in knee osteoarthritis (OA).6 This new evidence is consistent with our findings that the IPFP maximal area was associated with reduced …

  • response to Infrapatellar Fat Pad maximal area and changes in knee symptoms gender related difference or gender difference in reporting by bai et al
    Annals of the Rheumatic Diseases, 2016
    Co-Authors: Faming Pan, Xingzhong Jin, Zhenhua Liu, Xia Wang, Benny Antony, W Han, Flavia M Cicuttini, Graeme Jones, Changhai Ding
    Abstract:

    We would like to thank Bai et al for their interest in and comments on our paper titled ‘A longitudinal study of the association between Infrapatellar Fat Pad maximal area and changes in knee symptoms and structure in older adults’.1 First, we agree that the overall response rate was not high (57%). We identified the participants randomly from the local community using the electoral roll, and the reasons for not participating in this study were not being eligible, not being contactable and refusing to participate. The response rate is comparable to those (52–58%) from studies with equivalent response burdens conducted around the same time period.2 ,3 The moderate response rate can be offset by the high rate of retention at follow-up. Bai et al assumed that people with pain to start with were more likely to respond, and those with significant changes in pain symptoms over …

  • a longitudinal study of the association between Infrapatellar Fat Pad maximal area and changes in knee symptoms and structure in older adults
    Annals of the Rheumatic Diseases, 2015
    Co-Authors: Faming Pan, Xingzhong Jin, Changhai Ding, Zhenhua Liu, Xia Wang, Benny Antony, W Han, Flavia M Cicuttini, Graeme Jones
    Abstract:

    Background The Infrapatellar Fat Pad (IPFP) is of uncertain significance for knee osteoarthritis. The aim of this study was to describe the longitudinal associations between baseline IPFP maximal area and changes in knee pain, knee cartilage volume and cartilage defects in older adults. Methods 356 community-dwelling male and female adults aged 50–80 years were measured at baseline and approximately 2.6 years later. T1-weighted or T2-weighted Fat-suppressed MRI was used to assess maximal IPFP area, cartilage volume and cartilage defects at baseline and/or follow-up. Knee pain was assessed by the self-administered Western Ontario McMaster Osteoarthritis Index questionnaire. Results After adjustment for confounders, IPFP maximal area in women was significantly and negatively associated with changes in knee pain (β: −0.18 to −0.86 for total knee pain, pain at night while in bed, pain when sitting/lying and pain when standing upright, all p 2 at medial site; +0.86% per cm 2 at lateral site, both p Conclusions While the associations are not fully consistent, IPFP maximal area appears to have a protective role for knee symptoms and cartilage damage in older female adults.

  • Infrapatellar Fat Pad in the knee is local Fat good or bad for knee osteoarthritis
    Arthritis Research & Therapy, 2014
    Co-Authors: Xingzhong Jin, Shiji Cai, Zhenhua Liu, Xia Wang, Benny Antony, Y Cao, W Han, D Aitken
    Abstract:

    Recent studies regarding the Infrapatellar Fat Pad (IPFP) mainly focus on the roles of the cells derived from the IPFP. There have been few clinical or epidemiological studies reporting on the association between the IPFP and knee osteoarthritis (OA). Our objective is to generate hypotheses regarding the associations between IPFP maximum area and knee OA measures in older adults. A total of 977 subjects between 50 and 80 years of age (mean, 62.4 years) participated in the study. Radiographic knee osteophyte and joint space narrowing (JSN) were assessed using the Osteoarthritis Research Society International atlas. T1- or T2-weighted Fat suppressed magnetic resonance imaging (MRI) was utilized to assess IPFP maximum area, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. After adjustment for potential confounders, IPFP maximum area was significantly associated with joint space narrowing (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.62 to 0.91 (medial), 0.77, 95% CI: 0.62 to 0.96 (lateral)) and medial osteophytes (OR: 0.52, 95% CI: 0.35 to 0.76), knee tibial and patellar cartilage volume (β: 56.9 to 164.9 mm3/cm2, all P <0.001), tibial cartilage defects (OR: 0.58, 95% CI: 0.41 to 0.81 (medial), 0.53, 95% CI: 0.40-0.71 (lateral)), any BMLs (OR: 0.77, 95% CI: 0.63 to 0.94), and knee pain on a flat surface (OR: 0.79, 95% CI: 0.63 to 0.98). IPFP maximum area was negatively, but not significantly, associated with femoral cartilage defects, lateral tibiofemoral BMLs, and total knee pain or other knee pain subscales. IPFP maximum area is beneficially associated with radiographic OA, MRI structural pathology and knee pain on a flat surface suggesting a protective role for IPFP possibly through shock absorption. Consequently, we must pay special attention to IPFP in the clinical settings, avoiding resection of normal IPFP in knee surgery.